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Biomedical subjects

C M Wilcox

Publications and source records attributed to C M Wilcox.

At least 127 records · Page 7Linked to original sources
PubMed1991

High-protein ascites in patients with the acquired immunodeficiency syndrome.

Diseases of the liver or peritoneum resulting in ascites have been infrequently reported in patients with the acquired immunodeficiency syndrome. Since 1985, eight noncirrhotic patients with the acquired immunodeficiency syndrome presenting with new onset high-protein ascites have been evaluated. All but one patient had nondiagnostic paracentesis studies. Laparoscopy with biopsy of identified abnormalities or percutaneous omental biopsy were diagnostic in four patients. Non-Hodgkin's lymphoma was the cause in three patients, and disseminated cryptococcosis occurred in one patient. In the four other patients, chronic nonspecific peritonitis was found at laparoscopy; follow-up of these latter patients, including exploratory laparotomy in one patient and autopsy in two patients, disclosed no specific cause. Patients with the acquired immunodeficiency syndrome and high-protein ascites of uncertain etiology should undergo directed peritoneal evaluation as a potentially treatable disorder may be found. However, despite extensive evaluation, a subset of patients in whom no specific cause can be identified still remains.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Characterization of human immunodeficiency virus type 1 strains recovered from the bowel of infected individuals.

HIV-1 isolates were recovered from biopsy tissues from the small bowel, colon, and rectum of 10 infected individuals with severe diarrhea. In general, the bowel strains grew well in primary macrophage and lymphocyte cultures, not in T or B cell lines. They induced cytopathic effects such as syncytia formation and cell killing in peripheral blood mononuclear cells and were usually sensitive to serum neutralization. Several of these isolates were able to infect bowel epithelial cell lines, but this characteristic was also observed with blood-derived strains. Differences could be identified in 3 of 6 cases of paired bowel and blood isolates from the same individual. When compared to blood-derived isolates, the bowel strains exhibited a relative inability to grow in established cell lines, a reduced ability to induce cytopathology in infected cells, and a greater sensitivity to serum neutralization. Thus, although distinct characteristics of bowel-derived HIV-1 strains were not found, certain biological and serological properties might differentiate these viruses from those isolated from other tissues.

Biopsy↗
PubMed1990

Cytomegalovirus esophagitis in patients with AIDS. A clinical, endoscopic, and pathologic correlation.

OBJECTIVE: To examine the clinical presentation, endoscopic features, laboratory diagnosis, and outcome of cytomegalovirus esophagitis in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Retrospective review of endoscopy records and esophageal biopsy material from patients with AIDS during the 24-month period from 1986 to 1988. SETTING: Urban medical center, central receiving county hospital. PARTICIPANTS: Sixteen inpatients or outpatients seen by gastroenterology consultants at a single hospital. INTERVENTIONS: Endoscopy with multiple mucosal biopsies and viral culture of all esophageal mucosal lesions. Proven or suspected cyclomegalovirus disease was verified in patients using immunohistochemical antibody staining of mucosal biopsy specimens. MEASUREMENTS AND MAIN RESULTS: Odynophagia was the most prominent esophageal symptom, seen in 14 of 16 patients with cytomegalovirus esophagitis confirmed by immunohistochemical staining. Ulcerations of the esophagus were identified in all but 1 patient and typically appeared as large, solitary, shallow lesions. Routine hematoxylin and eosin staining of esophageal mucosal and submucosal specimens showed intranuclear inclusions in all patients, whereas cytomegalovirus culture was positive in only 8 of 14 patients. Cytomegalovirus esophagitis was associated with a poor long-term prognosis. CONCLUSION: Cytomegalovirus esophagitis in patients with AIDS is a well-defined entity with characteristic clinical symptoms and endoscopic findings, as well as histopathologic abnormalities.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Cytomegalovirus-associated acute pancreatic disease in patients with acquired immunodeficiency syndrome. Report of two patients.

Pancreatic disease has been infrequently reported in patients with acquired immunodeficiency syndrome. Over the last 3 years at our hospital, two patients with the acquired immunodeficiency syndrome and acute pancreatic or biliary disease, demonstrated at autopsy to be secondary to cytomegalovirus infection of the pancreas, have been evaluated. However, pancreatic disease was not recognized antemortem in our two patients because of their underlying diseases and the atypical presentation. Cytomegalovirus infection of the pancreas may cause acute symptomatic disease in patients with acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Campylobacter-like organisms are uncommon pathogens in patients infected with the human immunodeficiency virus.

Over a 25-month period, we prospectively evaluated 36 patients with symptomatic human immunodeficiency virus disease (including 27 with unexplained chronic diarrhea) by flexible sigmoidoscopy for the presence of Campylobacter-like organisms. No Campylobacter-like organisms were isolated. Campylobacter-like organisms appear to be an uncommon cause of idiopathic chronic diarrhea in symptomatic human immunodeficiency virus disease.

Campylobacter↗
PubMed1988

Gastrointestinal bleeding in patients receiving long-term anticoagulant therapy.

When gastrointestinal (Gl) bleeding occurs in patients receiving anticoagulation, an underlying pathologic lesion is usually suspected and a thorough diagnostic evaluation is undertaken. Over a 15-year period, 50 patients were identified as having Gl bleeding while receiving warfarin. Approximately half of all bleeding episodes occurred from the upper Gl tract, with a lesion identified 81 percent of the time, usually peptic ulcer disease. Lower Gl bleeding occurred in one-third of bleeding episodes, with a diagnosis made in only 52 percent. Only three neoplasms were found and all were diagnosed by barium studies. No diagnosis was established in 47 percent of all bleeding episodes despite appropriate evaluation; in these patients, a mean follow-up of 39.6 months disclosed no premalignant or malignant lesions. Mortality associated with bleeding was less than 2 percent. These data suggest that a diagnosis is usually established in patients receiving anticoagulation who experience upper Gl bleeding, whereas the cause of lower Gl bleeding may remain occult even after a thorough evaluation; however, the absence of a definitive diagnosis carries a good prognosis.

Adult↗
PubMed1988

Evaluation and treatment of gastrointestinal tract hemorrhage in patients with AIDS.

Hemodynamically significant gastrointestinal tract hemorrhage is infrequently seen among patients with AIDS. During a 35-month period, we evaluated 37 AIDS patients with substantial gastrointestinal tract bleeding: 13 patients had upper gastrointestinal disease; 24 patients had colorectal disease. AIDS-associated lesions were identified as the etiology of the hemorrhage in 8 of 13 patients with upper and 9 of 24 patients with lower gastrointestinal tract bleeding.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Stress ulcer prophylaxis in medical patients: who, what, and how much?

Stress ulcers are a frequently encountered problem in critically ill medical patients. Gastric acid and decreased gastric mucosal blood flow appear to be important in the pathogenesis of these lesions. Occult bleeding from stress ulcers is common, although significant bleeding occurs in less than 20% of patients. The mortality of bleeding is dependent on the severity of the underlying diseases. A number of processes have been suggested as risk factors; however, prolonged mechanical ventilation, a coagulopathy, and the presence of more than one risk factor place the patient at greatest risk. Titration of the gastric pH to greater than four with either antacids or H2-receptor antagonists provides effective prophylaxis. The continuous infusion of the H2-receptor antagonists is also efficacious. Sucralfate appears to be another useful alternative with several potential advantages. Prophylactic therapy decreases the incidence of stress ulcer-related bleeding, although it does little to improve the survival of the critically ill patient.

Antacids↗
PubMed1987

Spontaneous bacterial peritonitis. A review of pathogenesis, diagnosis, and treatment.

Spontaneous bacterial peritonitis (SBP) is an increasingly recognized complication of cirrhosis with ascites. However, the presence of ascites from any cause appears to be a risk factor for this infection. The etiology of SBP is multifactorial, including derangements in the reticuloendothelial system, abnormalities of both the serum and ascitic fluid humoral immune systems, and systemic bacteremia. Gram-negative enteric pathogens are the etiologic agents in 70% of the cases; anaerobes are an uncommon cause. Fever and abdominal pain are the most common presenting symptoms. However, asymptomatic patients are being increasingly recognized. When SBP is suspected, paracentesis is indicated. An absolute polymorphonuclear leukocyte count greater than 500/mm3 is highly suggestive of SBP. Ascitic fluid lactate and pH may offer additional diagnostic assistance when the PMN count is ambiguous. Appropriate antibiotic therapy should be initially based on the centrifuged Gram stain of ascites as well as the patient's renal function. Mortality is substantial and appears to be related to the severity of the underlying liver disease.

Bacterial Infections↗
PubMedDate not supplied

Utility of droperidol for conscious sedation in gastrointestinal endoscopic procedures.

Although narcotics and benzodiazepines are widely used as premedications for gastrointestinal endoscopic procedures, we have found a significant number of patients in whom this combination is either inadequate for sedation or results in paradoxical agitation. Over the last 54 months, we have administered droperidol, a neuroleptic, as an adjunct to narcotics and benzodiazepines in 764 patients undergoing 1,102 procedures. The most common indication for droperidol usage was active alcohol abuse or withdrawal (45%). The most frequent dose administered was 2.5 mg (41.1%) followed by 3.75 mg (25.8%). The level of sedation and cooperation was adequate in all but 22 procedures (2.0%). Complications related to droperidol use were infrequent, occurring in 17 procedures (1.5%). There was no mortality or major morbidity resulting from droperidol usage. In our endoscopic population, we find droperidol to be a safe and efficacious adjunctive agent for conscious sedation.

Anxiety↗
PubMedDate not supplied

Prospective endoscopic characterization of cytomegalovirus esophagitis in AIDS.

Cytomegalovirus (CMV) esophagitis is an important cause of esophageal ulceration in patients with the acquired immunodeficiency syndrome. However, the endoscopic appearance of these lesions has not been well characterized. During a 3-year period, we identified 141 CMV esophageal ulcerations endoscopically in 33 patients. CMV esophagitis was the index diagnosis of human immunodeficiency virus (HIV) infection in 8 patients. Odynophagia was almost uniformly present, although gastrointestinal bleeding was the initial manifestation in 5 patients. Multiple ulcers were identified in 58% of patients. Giant ulcers were seen in 28%, whereas 43% of the lesions were less than 1 cm in greatest dimension. The majority of the lesions were located in the middle to distal section of the esophagus. The ulcers were characterized as either shallow or of intermediate depth in 74% of patients; deep ulcers were seen in 8%; diffuse erosive disease was found in 6%; and the ulcers had a "heaped up" appearance in 12%. In contrast to reports from previous studies, CMV esophageal disease appeared highly variable endoscopically. Multiple, well-circumscribed ulcerations were the most common endoscopic findings, although lesions could vary in number, size, and appearance. As this lack of uniformity may cause CMV esophagitis to be confused with other conditions characterized by esophageal ulceration, all HIV-infected patients with esophageal ulceration should undergo endoscopy with biopsy so that a definitive diagnosis can be obtained.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Short-term in vitro culture and molecular analysis of the microsporidian, Enterocytozoon bieneusi.

The microsporidium, Enterocytozoon bieneusi, causes a severe, debilitating, chronic diarrhea in patients with the acquired immunodeficiency syndrome. Specific diagnosis of intestinal microsporidiosis, especially due to Enterocytozoon, is difficult and there is no known therapy that can completely eradicate this parasite. Preliminary studies indicate that a short term (about 6 months) in vitro culture of this parasite yielding low numbers of spores, may be established by inoculating human lung fibroblasts and/or monkey kidney cell cultures with duodenal aspirates and or biopsy from infected patients. The cultures may subsequently be used for the isolation and molecular analysis of parasite DNA.

AIDS-Related Opportunistic Infections↗